From the Guidelines
The best initial management for a patient presenting with sudden loss of consciousness and emotional distress is to first ensure patient safety by following the sequence of life support as outlined in the European Resuscitation Council guidelines, which includes opening the airway, checking for breathing, and removing any visible obstruction from the mouth 1. When a patient presents with sudden loss of consciousness and emotional distress, the priority is to ensure their airway is secure and they are breathing properly.
- The first step is to open the patient's airway by lifting their chin and tilting their head, as recommended by the European Resuscitation Council guidelines 1.
- Next, check for breathing by looking, listening, and feeling for air on the cheek, and remove any visible obstruction from the mouth.
- After ensuring the patient's airway and breathing are stable, a rapid assessment of vital signs should be performed, including pulse, blood pressure, respiratory rate, and oxygen saturation.
- Establishing intravenous access for potential medication administration and obtaining a blood glucose reading to rule out hypoglycemia are also crucial steps.
- While diagnostic tests such as CT brain, EEG, ECG, cardiac enzymes, glucose, and electrolytes may be necessary to determine the underlying cause of the loss of consciousness, the initial management should focus on stabilizing the patient and ensuring their safety.
- Continuous cardiac monitoring and supplemental oxygen should be provided as needed, and short-acting benzodiazepines such as lorazepam may be considered for acute anxiety management upon regaining consciousness.
From the Research
Initial Management
The best initial management for a patient presenting with sudden loss of consciousness and emotional distress involves a careful history, physical examination, and electrocardiograms 2.
Diagnostic Approach
A 12-lead electrocardiogram (ECG) is the only instrumental test recommended for the initial evaluation of these patients 3. The ECG may disclose an arrhythmia associated with a high likelihood of syncope, avoiding further evaluations and permitting institution of specific treatment.
Laboratory Tests
While troponin I estimation may predict 1-month serious outcome or all-cause death in syncope, it provides little additional benefit to the presenting ED ECG in identifying patients with syncope due to acute myocardial infarction (AMI) 4.
Key Considerations
- A careful, well-conducted medical history focused on the suspected syncopal event is crucial for the diagnosis 3.
- A primary survey followed by a secondary survey with special attention to immediate life-threatening reversible causes is recommended 5.
- A systems-based approach searching for any other life-threatening or reversible causes is necessary 5.
- A comprehensive emergency department evaluation including a detailed history and physical exam as well as laboratory and radiographic testing is needed 5.
Diagnostic Tools
- Electrocardiogram (ECG) is a mandatory diagnostic tool 3.
- CT brain, EEG, or cardiac enzymes may be considered based on the patient's presentation and history, but are not recommended as initial tests 2, 3, 4.
- Glucose and electrolytes may be considered as part of the initial laboratory tests to rule out other causes of altered mental status 5, 6.